Permit .71 CITY OF TIGARD ELECTRICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELC2010 -00612
T t G A g D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/02/2010
Parcel: 1S136AD02501
Jurisdiction: Tigard
Site address: 10570 SW 71ST AVE
Subdivision: VILLA RIDGE Lot: 4
Project: Martin
Project Description: Panel replacement with sub panel and (4) circuits.
Owner: FEES
MARTIN, WALLACE D AND BETTY J Quantity Description Date Amount
10570 SW 71ST AVE
TIGARD, OR 97223 2 ea Services or Feeders - 200 11/02/2010 $201.40
amps or less
PHONE: 4 crt Branch Circuits w /Purchase 11/02/2010 $29.68
Service or Feeder
1 ea 12% State Surcharge - 11/02/2010 $27.73
Contractor: Electrical
WEST SIDE ELECTRIC CO INC
1834 SE 8TH AVE
PORTLAND, OR 97214
PHONE: 503 - 231 -1548
FAX: 503- 736 -0677
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $258.81
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of . irect questions to OUNC by calling 503. 6.6699 or 1.800.332.2344. .
Issued BY2/ Permittee Signature: G, 0 & ra. a/ y
4111tW OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Oct 29 2010 5: 39PM West Side Electric 503-736-0656 p.2
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Electrical Permit Aaplicati 1 (Hz ,,i'l • 1( 1 1,i.
City of Tigard .
II
13125 SW Ha/1 Blvd., Tigard, OR
Phone: 503.639.4171 Fax: 503.598.1
tion Line: 503.639.4175 i 29 2010 Date Rady/B:
Internet: www.tigarcl-or.gov CEIVED
bt
. Received .
Date/11 . IF/WI, 0 ElffiffirOWMPIN
IPElilliU111111111
oy
Notifred/blethod: Other Pennit:
Inspec
E See Page 2 for
._ 0 , •
FM Supplemental Intimation
. ....,.i..lso A tippolitIA:gfitii.{ gze.ansIgmiwitniaiiisswarratrwipt
0 New constriction pr Addition/a 'Ls , .1...; . .. , .!!... ItIMN Please check all that apply (submit isms of pima wAtems checked below 0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
L40_140:1130tA.SIVel0.44W.******10.010049001`70,74-7A exceeds 10,000 amps at 150 wilts or 0 Floating buildings.
less to ground, or exceeds 14.000 0 Commereiel•use agricultural
g 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for an other instdIstions. buildings.
0 Ivluiti-family 0 Master builder 0 Other: 0 Fire pump. 1] Installation of 73 KVA or
1,4 Mtil t ,V., 1 040F 4 -4, 1 04#6040101~.00 • 04iggiiiiktigI4V.ggi:Vini Ci Ein sY""' larger sepanuely derived system
J 1.00HP or morc. occupancy.
Job no.: y SOWST Job site address: /0S fit) 7/ *--- 0 Six or ITIOTC residential units. 0 Recreati cast vehicle parks
City/StateJZIP: 14, 77, / k-e/Ver / 9 7273 . 0 Health &willies. 0 Supply voltage for more duo
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project natne: jy.7h //auv ,. 0 Servia or feeder amps or , , , , .
iMMY,i'.7!:
Cross street/directions to job site: neacrionon ' l ob. Fee. 1 Total I •
New residential single- or nimbi-family dwelling unit
Inelndes abscised garage.
Subdivision: Lot no.: 1,000 mi. ft or less 16854 4
Ea add 'I 500 sq. ft, or portion 33.92 1
Tax mapiparcel no.: Limited energy, residential
j :Y;?* -. 4 , '' -:',-- stt'.: '..li.f.i. , ..nvits ,, , ,. .0..zolcfr,04 - ,:g4;11, - :-.4 , ,, , a, (with above sq. ft.) 73.00 2
Limited energy, multi-family
75.00 2
• Pefrul chi? e , e. svi A44a) =A- ‘1Pc"'6 residential (with above so. ft.)
i / Services or feeders installation alteration. and/or relocation
200 amps or less Z_ ..._ 100.70 ZO/ I I-L -7 2
' 'cillr'.. '''' • '"' ' •", ' " 'i.
kft,Nlit 4-, 201 amps to400 amps 13356 2
• 401 amps 10 600 amps . 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 stops or volts _ 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or less
. 08 1 12595136 1
201 arnps 10 400 araps 2
Owner Installation: This installation is being made on property that 1 own which is not
aolamps 599 amps 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. to
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Foe for branch circuits with
d
'-- :* 41. 'N • ' 7,3i>1 ..., ., I . allat . C: i'tIi^t.:*: above service or feeer fee, 6.k
. 4„ ; „„ .4if.: , ...,, , . .,„ , .,..i..:,,.F.,h..i;.1.: -.... ini_,!:...2..-sq.= - „.... b. y , • . , .:,;;..yr...4.1,:a• each branch cirtuit 41 7.42 2 2
B B. Fee for branch circuits wirhour
usiness name:
service or feeder fen, first
56.18 2
, branch circuit
Contact name: add'I branch circuit 7.42 2
Address: hisscellaneons (service or feeder not included)
Each manufactured or modular
City/State/ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.80 2
E-mail: Sign or outlinelighting 67.84 2
laWatqacelf0.74,'W Siva! cineuins) or bmited-etiergy
panel, alteration, or extension Page 2 2
Business name: West Side Electric Co., Inc. Each additional inspectioa over allowable in any °lithe above
Address: 1834 SE 8th Ave. Additional inspection (1 hr min) 66.25/ h.r
Investigation (1 hr min) 66.25/Iu
City/sate/ZIP: Portland/OR/97214 Industrial plant (1 hr min) 713.18/ hr
Phone: ( 503) 231 . Fax:(503) 736 Inspections for which no fee is
90.00/ lir
— ificsi listed 'A Isr min
CCI3Lie.: 13306 Electrical Lic.: 26 Suprv. Lic.: 4654
i e 4• 1".t-p.:-::-:::,.c.;.Y>i's.....•1.._,1,:„.2._,_LL.L.-,..7.L.,117.,,...st.
rev.., .-
Subtotal: / 3) ..-•
Suprv. Electrician signature, required: Plan review (25% of permit f a r ..,,, / /0
/ rmit fee):
Print name: Randall F Roberts Date: //
State surcharge (12% of permit fee): Z7
TOTAL PERMIT FEE: 2 , 4 - g gi
Authorized signature: This permit application expires If • permit b not obtained within 180
days after le tits been accepted as complete.
Print name: I Date: • Number of inspections allowed per permit.
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